| Background:Traditional incision and fusion internal fixation is widely used in clinic because of its advantages such as clear exposure,complete decompression and firm fixation.Due to the influence of a variety of factors during the perioperative period,such as the time for nerve root compression before operation,the traction of nerve root during operation,the peeling injury of soft tissue and the destruction of bone structure,postoperative inflammatory reaction,hematoma formation and individual difference in pain tolerance,etc.,so that the probability of pain after lumbar surgery is as high as 20%,and postoperative residual pain symptoms can not be ignored[1].The postoperative pain of lumbar vertebrae causes a great mental burden on the patients and has a negative effect on their postoperative rehabilitation.For postoperative residual low back pain,non-steroidal anti-inflammatory painkiller(NSAIDs),is the most commonly used in clinic,but the gastrointestinal risk caused by long-term use of non-steroidal anti-inflammatory drugs can not be ignored[2].At present,conservative treatment is the main treatment of postoperative pain,while traditional Chinese medicine is widely used in clinic because of its simplicity,convenience,test,cheapness and relatively high safety.Patients with lumbar disc herniation are affected by surgical injury,intraoperative blood loss and other factors,patients often have varying degrees of fatigue symptoms after operation,at the same time,surgical treatment is easy to damage meridians,resulting in meridian qi and blood stasis,so the early postoperative manifestations are qi deficiency and blood stasis.It has been reported in previous literature that TCM treatment of pain of qi deficiency and blood stasis after lumbar surgery is mainly from the point of view of replenishing qi and activating blood circulation.Prescriptions often choose Buyang Huanwu decoction,Huangqi Guizhi Wuwu decoction and so on.Astragalus membranaceus is used as monarch medicine,focusing on tonifying spleen.However,there are few studies on the therapeutic effect of tonifying the qi of liver and kidney in the treatment of lumbar pain after lumbar vertebrae operation.because the pathological changes of Zang-fu organs of low back pain after operation are in the kidney,and the pathology is based on deficiency and blood stasis,and is related to the governor pulse,the treatment should be based on the principle of tonifying the liver and kidney and removing blood stasis.Therefore,the famous prescription Sansheng decoction recorded in the differentiation of symptoms and signs of Chen Shiduo in the Qing Dynasty was adopted,which was composed of three warm medicines,namely Eucommia ulmoides,Atractylodes macrocephala and Cornus officinalis.At the same time,it is supplemented with chicken blood vine,sappan wood and Achyranthes bidentata to achieve the treatment purpose of warming liver and kidney,replenishing qi and removing blood stasis.In this study,patients with prolapse of lumbar intervertebral disc were treated with fusion and internal fixation.Modified Sansheng decoction was selected and randomized controlled trial was used.Visual analogue pain score(VAS)and treatment score of Japanese Orthopaedic Association(JOA)were used to observe the clinical effect of modified Sansheng decoction in relieving pain of liver and kidney deficiency,qi deficiency and blood stasis after lumbar disc herniation.To provide clinical basis for the treatment of lumbar postoperative pain with traditional Chinese medicine.At the same time,as one of the representative applications in the field of traditional Chinese medicine research,network pharmacology can abstract the complex interaction between drugs and the body to form a biological network.With the help of the research method of network pharmacology,the drug-target-disease network of Sansheng decoction and postoperative pain was constructed,the core drug components were screened,and then its action mechanism was analyzed.Objective:To observe the clinical efficacy of modified Sansheng decoction in the treatment of postoperative pain of qi deficiency and blood stasis in patients with lumbar disc herniation,to analyze the mechanism of modified Sansheng decoction in the treatment of pain after LDH,to promote the rapid recovery of lumbar vertebrae after operation,and to provide new ideas and new methods for the treatment of postoperative pain of lumbar vertebrae with traditional Chinese medicine.Methods:The inpatients were selected from the Spinal Department of Wangjing Hospital of Chinese Academy of traditional Chinese Medicine from September 2019 to March 2021.Sixty-four patients with posterior lumbar fusion and internal fixation were randomly divided into control group(n=32)and experimental group(n=32).The control group was treated with routine treatment,including anti-infection,nerve nutrition,edema elimination,functional exercise and nursing,while the treatment group was treated with Sansheng decoction on the basis of routine treatment.the prescription is composed of Eucommia ulmoides,Atractylodes macrocephala,Cornus officinalis,chicken blood vine,sappan wood,Achyranthes bidentata.Decoction in water,1 bag/time,twice a day,half an hour before meal in the morning and evening,for two weeks.Data were collected at four time points before treatment,7 days after treatment,14 days after treatment and 28 days after treatment.VAS score and JOA score were observed,and the curative effect was evaluated.Search the TCMSP database platform,establish the compound database of Eucommia ulmoides,Atractylodes macrocephala,Cornus officinalis,Fructus Atractylodis,Radix Atractylodis,Achyranthes bidentata,use drugbank and disgenet database,integrate the related pain target data set,use DrawVennDiagram online drawing platform to cross and map the drug target and disease target data set,obtain the intersection target of Sansheng decoction flavor and pain,and input it into string database.The protein-protein interaction network map of modified Sansheng decoction in the treatment of pain after LDH was obtained.finally,GO enrichment analysis and KEGG pathway analysis were performed.Results:There was no significant difference in sex,age,course of disease,fusion segment,duration of operation and intraoperative blood loss between the two groups(P>0.05),but there was comparability between the two groups.VAS scores within the group:7 days after treatment,14 days after treatment,28 days after treatment,respectively,compared with before treatment,there was significant difference between the two groups(P<0.05),but there was no significant difference between the two groups at 7 days after treatment,14 days after treatment,28 days after treatment,the difference was statistically significant(P<0.05).JOA score group comparison:7 days after treatment,14 days after treatment,28 days after treatment,respectively,there were significant differences between the two groups(P<0.05),and between the two groups:7 days after treatment,14 days after treatment,28 days after treatment,there were significant differences between the two groups(P<0.05),and there were significant differences between the two groups at 7 days after treatment,14 days after treatment,28 days after treatment(P<0.05).The total effective rate of the control group and the observation group was 75%and 93.75%respectively,and the total effective rate of the observation group was higher than that of the control group,and there was significant difference between the two groups(P<0.05).Both groups had high safety and no adverse reactions occurred.There are 77 active compounds in the flavor of St.Tang,such as β-sitosterol,kaempferol,quercetin,etc.,the main gene targets include ALB,TP53,TNF,PTGS2,etc.,involving a variety of biological processes,such as response to toxic substances,blood circulation,nutritional status,membrane raft,nuclear membrane,transcription factors,protein coupling amine receptor activity,protein domain specificity,antioxidant activity and so on.Enrichment pathways include neuroactive ligand receptor interaction,cGMP-PKG signal pathway,serotonergic synapses and so on.Conclusion:(1)this study emphasizes the importance of warming and tonifying the liver and kidney after operation,indicating that part of the pathogenesis of pain after LDH is blood stasis caused by qi deficiency of liver and kidney.The treatment is based on the basic principle of "tonifying liver and kidney and removing blood stasis",which enriches the connotation of syndrome differentiation and treatment of postoperative pain of lumbar vertebra.(2)Oral Sansheng decoction is more effective and safe in improving the degree of postoperative lumbar pain than conventional treatment,so it is worthy of clinical application.(3)the network pharmacology reveals the chemical composition and gene target of Sansheng decoction in the treatment of pain after LDH,and defines the role of Sansheng decoction in anti-inflammation,pain relief and immune regulation,which provides theoretical support for Sansheng decoction in the treatment of pain after LDH. |
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